Commentary, Trump Administration

U.S. House vote on ACA repeal and Medicaid matters to me

The first brief in the Medicaid Matters series aims to raise awareness and understanding as to why Medicaid is important not only to nearly 75 million Medicaid beneficiaries across the U.S., but to all North Carolinians. While I am passionate about the work I do as part of the Health Advocacy Project, there is a very personal reason why today’s U.S. House vote on proposals to restructure Medicaid as written in the American Health Care Act and the manager’s amendment worries me.

Like many others in my age range, I have reached the stage of life where I have taken on more responsibility for the health and well-being of my parents. My father was diagnosed with early onset Alzheimer’s disease over ten years ago. The early stages of the disease were challenging, but my family and I developed techniques to calm his fears as he realized that his memory was slipping away from him. My mother retired early to become his full-time caregiver, but recently my father’s Alzheimer’s has progressed to a more advanced stage, and caring for him at home took a toll on her health as well. My father now requires full-time supervision in a locked memory unit at a nursing home. The severity of his condition and health care needs are why restructuring Medicaid into a block grant or “per capita cap affects me.

In the U.S. and North Carolina, three out of every five nursing home residents receive the care they need because they have Medicaid coverage. My father is termed a dual eligible – as a person over 65 years old, he has Medicare, which covers his primary, acute, and post-acute care, but because he needs long-term nursing care, he also has coverage under Medicaid because nursing home services are not covered by Medicare. My father wasn’t always a dual eligible, but after months of paying for expensive nursing home care out-of-pocket, my parents’ savings that was intended for fun retirement activities dwindled to zero as his health care needs increased.

If Congress fails to block the American Health Care Act and Medicaid is restructured into a block grant or per capita cap, my father’s health is at risk. The Congressional Budget Office’s evaluation of the GOP proposal to repeal the ACA and restructure Medicaid shows that funding from the federal government for Medicaid would be cut by $880 billion by 2026. If that dollar amount isn’t shocking enough, the cuts in funding would lead to 14 million people being cut off Medicaid. Advocates and researchers have noted that if funding for state Medicaid programs is cut by either a block grant or per capita cap proposal, states will have three options to reduce Medicaid costs  – 1) cut Medicaid services, 2) cut Medicaid enrollment, or 3) cut payments to providers.

How will states like North Carolina respond to these deep and devastating cuts in federal funding? Will they make reductions to coverage for nursing home care and long-term care services? Will cuts be made to older adult enrollment? Or will states lower payments to providers to the point that they will not be able to cover the costs associated with providing care to the most vulnerable patients? These cuts put my father’s and millions of other American’s health at risk who depend on nursing home and long-term care. My father spent his life serving others — as a veteran, a police officer, and a church volunteer. He enjoyed public service and did not expect to be diagnosed with Alzheimer’s disease right after he retired. As a man who worked all of his life, served his country, his community, and provided for his family, I ask Congress to recognize that he, and millions of other Americans like him, deserve to continue receiving necessary health care services under Medicaid.  That’s why I’m hoping that Congress votes “No,” and protects the care of millions of Medicaid beneficiaries.

NC Budget and Tax Center, Trump Administration

Coverage losses, cost shifts to North Carolina could result from US House vote today on health care coverage

The U.S. House of Representatives is set to vote on the American Health Care Act today which seeks to strip the health care coverage extended to millions of Americans in recent years, shift the cost of health care onto middle and low income consumers and give the wealthiest taxpayers a tax cut.

It has been called by many the greatest redistribution upward in memory.

It is also a cost shift onto states.  North Carolina policymakers would have to find an estimated $6.6 billion over 10 years to maintain the Medicaid program alone.  To do so, state policymakers will have to raise taxes or cut services or cut off people from health care or cut payments to providers.  At a time when North Carolina’s leaders are contemplating their existing spending priorities with a tax code that continues to fall short of the needs, finding an additional $6.6 billion over ten years will be impossible without many of these steps.

The proposed restructuring of Medicaid represents unnecessary changes to a program that serves the state’s most vulnerable residents efficiently and with the goal of improving health outcomes of all North Carolinians.  This is a retreat by the federal government that will leave state policymakers responsible for the rationing of care and fallout from the health care industry.

Over time, as my colleague Luis Toledo detailed in recent analysis, these pressures on state government will grow.  The adjustment of the amount that the federal government will provide to North Carolina is not sufficient to keep up with the cost of services nor will it allow the state to contend with the next public health crisis or emerging treatments for existing diseases.

The loss of health care coverage through the dismantling of the Affordable Care Act and the restructuring of Medicaid will ripple through North Carolina, impacting families, health care providers and, yes, the economy.

Commentary, public health, Trump Administration

Congress sneaking in last-minute change to make Trumpcare even worse

Ahead of a floor vote scheduled for later today, Republican leadership in the House has realized that they do not have enough votes right now to pass the American Health Care Act (AHCA), the Trump-Ryan proposal to repeal and replace the Affordable Care Act (ACA). As a result, Trump and others are trying to sneak in disastrous last-minute changes to an already terrible bill to win over conservative votes at the expense of millions of lives.

One such change that they are proposing is repealing the requirement that health insurance plans cover a core set of essential health benefits. This guarantees that plans provide coverage for core services, such as hospitalizations, maternity care, prescription drugs, as well as mental health and substance use disorder treatment.

If this provision is repealed, insurers could offer bare-bones plans that don’t cover services that North Carolinians need, meaning only the most expensive, premium plans would cover services like treatment for opioid addition, for example.

What’s more, other key consumer protections would fall apart. While the AHCA does not repeal the ACA’s prohibition on lifetime limits and annual caps on services, that protection is useless without the essential health benefits requirement. Current law only applies these protections to services considered essential health benefits. If this provision is repealed, insurers may be free once again to arbitrarily cut off coverage for patients because their treatment is too expensive.

The haste with which Congress and Trump are moving to repeal our health care is telling; why rush to change one-sixth of the U.S. economy and millions of lives unless you don’t want the public to see what you’re doing? After all, we still haven’t seen the bill language that the House will vote on today. It seems like the Republicans may have to pass the bill to find out what’s in it.

Commentary, Trump Administration

Trump budget would eliminate professional development funding for NC educators

President Trump’s 2018 budget blueprint offers bad news for public schools. His proposal – which, thankfully, has a way to go before becoming law – proposes eliminating all professional development funding for teachers and principals. The elimination of the $2.4 billion Supporting Effective Instruction State Grants program (also known as Title II) would reduce North Carolina school districts’ budgets by approximately $45 million and leave North Carolina school districts without any dedicated funding for professional development.

The elimination of federal professional development funding follows a path already pursued by the North Carolina General Assembly. Prior to the Recession, the state provided school districts with approximately $12.5 million per year for staff development. That funding was eliminated, on what was supposed to be a temporary basis, until state revenues recovered. In 2011, the General Assembly permanently eliminated dedicated state funding for professional development.

The elimination of professional development funding flies in the face of research. High-quality professional development (training that is job-embedded, ongoing, and differentiated) has a direct impact on student achievement. A comprehensive meta-analysis of the impact of professional development found that “teachers who receive substantial professional development…can boost their students’ achievement by about 21 percentile points.” Another more recent report concludes that “investments in high-quality principal training yield substantial benefits in student achievement, as well as teacher quality and retention.” Read more

NC Budget and Tax Center, Trump Administration

Trump’s budget will not make America great again

Budgets matter, both within government and inside each household across America. Within government, a budget in its most basic form equals policy priority. Yesterday, the White House released its first budget blueprint, also referred to as its skinny budget, and the consensus all around is that the proposed budget will not make America great again.

Instead, Trump’s proposed budget will hurt households and remove the foundational role of many federal programs that support the economy and neighborhood well-being.

The reason Trump’s budget will not make America great again is simple: Trump’s budget makes no attempt to prioritize the allocation of money against various important American needs and priorities in a strategic manner. Instead, the Trump budget blueprint makes it very clear that in order to make America great again it only has to address one policy goal: safety. The budget proposes a $54 billion increase in spending on defense.

The safety and security of America is vital. However, the recipe of what has truly made America great over time has been its ability to prioritize effectively various policies, including security, in order to serve all Americans and provide for a more prosperous future that considers a wide array of current and emerging issues. Eroding support to state and local governments, reducing investments in neighborhood well-being and limiting the economic security of Americans will undercut that goal. Read more